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Answers go in the bottom section.

a. Shocking

b. Dancing

c. Typing

d. Raining

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A 7-year-old child with spastic diplegic cerebral palsy (GMFCS Level II) is being seen in outpatient physical therapy to improve gait efficiency and reduce toe-walking. The therapist is considering the use of Functional Electrical Stimulation (FES) to assist with dorsiflexion during gait.                                          Which of the following is the MOST appropriate FES setup to assist this child during the swing phase of gait?   

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A 7-year-old child with spastic diplegic cerebral palsy (GMFCS Level II) is being seen in outpatient physical therapy to improve gait efficiency and reduce toe-walking. The therapist is considering the use of Functional Electrical Stimulation (FES) to assist with dorsiflexion during gait.                                          Which of the following is the MOST appropriate FES setup to assist this child during the swing phase of gait?   

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A. Place electrodes on the plantar flexors and use a continuous stimulation pattern during gait
B. Place electrodes on the anterior tibialis with a heel switch to trigger stimulation during stance phase
C. Place electrodes on the peroneal nerve and anterior tibialis with stimulation timed to activate during swing phase
D. Use symmetric biphasic stimulation over the quadriceps with ramp time of 5 seconds to reduce spasticity.

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What of the following is NOT a general contraindication for e-stim?

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What of the following is NOT a general contraindication for e-stim?

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A. Over a pacemaker

B. Impaired sensation over a distal area

C. Over the carotid sinus

D. During pregnancy (abdomen/ lower back)

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A physical therapist is considering the application of ESTIM for a patient with chronic LBP. Which of the following conditions would be considered a contraindication to the use of ESTIM on this patient?

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A physical therapist is considering the application of ESTIM for a patient with chronic LBP. Which of the following conditions would be considered a contraindication to the use of ESTIM on this patient?

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A. History of controlled HTN

B. Impaired sensation in the treatment area

C. Patient has a pacemaker

D. Patient reports occasional mild skin irritation from adhesive electrodes in the past

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A 65-year-old male patient is referred to physical therapy following a cerebrovascular accident (CVA) 4 weeks ago. He presents with right-sided hemiparesis and foot drop during ambulation. The physical therapist decides to use functional electrical stimulation (FES) to improve gait mechanics.

Question:

Which of the following represents the most appropriate application of FES to assist this patient during gait training?

A. Placement of electrodes on the gastrocnemius to stimulate during heel strike

B. Placement of electrodes on the tibialis anterior to stimulate during swing phase

C. Placement of electrodes on the quadriceps to stimulate during terminal stance

D. Placement of electrodes on the hamstrings to stimulate during pre-swing

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A patient is experiencing some discomfort during quad strengthening NMES. As the physical therapist you do not observe any muscle contraction occurring. What is the first thing you would change?

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A patient is experiencing some discomfort during quad strengthening NMES. As the physical therapist you do not observe any muscle contraction occurring. What is the first thing you would change?

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a. Turn up the intensity

b. Adjust electrode placement

c. Switch to TENS

d. Change the ramp time

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Which of the following best differentiates TENS from NMES?

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Which of the following best differentiates TENS from NMES?

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A. TENS is used to reduce spasticity through motor stimulation; NMES stimulates sensory nerves for pain.

B. TENS targets motor nerve stimulation exclusively; NMES targets both motor and sensory nerves.

C. TENS is used primarily for pain modulation; NMES is used to produce muscle contraction

D. TENS and NMES are interchangeable in treating muscle atrophy and chronic pain

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A 25-year-old recreational soccer player is referred to outpatient physical therapy 2 weeks after anterior cruciate ligament (ACL) reconstruction using a patellar tendon graft. The patient presents with visible quadriceps atrophy and difficulty performing a straight leg raise without knee extension lag. The physical therapist decides to use NMES to help strengthen the quadriceps.

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A 25-year-old recreational soccer player is referred to outpatient physical therapy 2 weeks after anterior cruciate ligament (ACL) reconstruction using a patellar tendon graft. The patient presents with visible quadriceps atrophy and difficulty performing a straight leg raise without knee extension lag. The physical therapist decides to use NMES to help strengthen the quadriceps.

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Which of the following NMES parameters is MOST appropriate for this patient to promote muscle strengthening?

A. Frequency: 35–80 Hz; Pulse Duration: 200–350 µs; On: Off Time = 1:5; Intensity: strong visible contraction

B. Frequency: 80–120 Hz; Pulse Duration: 100 µs; On: Off Time = 1:1; Intensity: sensory-level only

C. Frequency: 10–20 Hz; Pulse Duration: 100–200 µs; On: Off Time = 1:5; Intensity: slight muscle twitch

D. Frequency: 50–80 Hz; Pulse Duration: 400 µs; On: Off Time = 10:10; Intensity: submaximal contraction

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Mrs. Johnson has come in for a PT evaluation with concerns of edema in the distal portion of the left arm. Upon taking a history, you find that she experienced a fall on the stairs within the past week that resulted in a wrist sprain. The patient also has blisters near the axilla and elbow. When communicating with the patient, you find that she is often confused and has difficulty communicating. Mrs. Johnson is also 7 months pregnant. What is the best modality to use on Mrs. Johnson to help reduce her edema?

1. Ultrasound

2. Ice Massage

3. FES

4. MLD

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Which of the following is the primary mechanism of iontophoresis to facilitate transdermal drug delivery?

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Which of the following is the primary mechanism of iontophoresis to facilitate transdermal drug delivery?

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A. Electromigration

B. Electroporation

C. Electro-osmosis

D. Passive diffusion

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Pt comes into your clinic with c/o acute LBP. During the evaluation, it is found that the pt also has inflammation in the area. If you chose TENS for the pt, what time of stimulation would use to decrease their pain?

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Pt comes into your clinic with c/o acute LBP. During the evaluation, it is found that the pt also has inflammation in the area. If you chose TENS for the pt, what time of stimulation would use to decrease their pain?

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a: sensory

b: motor

c: subsensory

d: noxious

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A physical therapist is treating a patient with post-injury ankle swelling. The therapist selects NMES instead of TENS. Which of the following best explains this clinical decision?

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A physical therapist is treating a patient with post-injury ankle swelling. The therapist selects NMES instead of TENS. Which of the following best explains this clinical decision?

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A. NMES targets type I sensory neurons to reduce inflammation.

B. TENS reduces edema more effectively at higher frequencies.

C. NMES induces muscle contractions that compress venous and lymphatic vessels, assisting in fluid return.

D. TENS causes greater excitation of alpha motor neurons than NMES.

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1)    A 33-year-old patient is 7 months s/p from an ACL repair on his right knee. Patient is showing weak right quad contraction with no pain. Patient is able to perform exercises and shows no contraindications for e-stim. What parameters would be most appropriate for this patient:

a)     TENS 70Hz 300 micro sec

b)    NMES 70Hz 300micro sec

c)     TENS 10 Hz 100micro sec

d)    NMES 10Hz 100 micro sec

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A PT applies electrical stimulation to a patient recovering from a soft tissue injury. The patient reports feeling a strong but comfortable sensation without any visible muscle contraction. Which type of sensory-level stimulation is MOST likely being applied?

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A PT applies electrical stimulation to a patient recovering from a soft tissue injury. The patient reports feeling a strong but comfortable sensation without any visible muscle contraction. Which type of sensory-level stimulation is MOST likely being applied?

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1. Subsensory level

2. Sensory level

3. Motor level

4. Noxious level

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Which of the following correctly matches the drug name with its charge and effect?

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Which of the following correctly matches the drug name with its charge and effect?

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a) Lidocaine: positive; muscle relaxant

b) Dexamethasone: positive; anti-inflammatory

c) Lidocaine: positive; local anesthetic effects

d) Dexamethasone: negative; muscle relaxant

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After an incredible career Tom Brady suffered a major rotator cuff tear while playing pickleball against our very own Dr. Cope. With a lifelong use of painkillers and opioids for acute pain opioid abuse post-opt is a huge concern. What is something you can utilize right away to further help Tom during his recovery?

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After an incredible career Tom Brady suffered a major rotator cuff tear while playing pickleball against our very own Dr. Cope. With a lifelong use of painkillers and opioids for acute pain opioid abuse post-opt is a huge concern. What is something you can utilize right away to further help Tom during his recovery?

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A. NMES

B. Tapotement massage

C. TENS

D. Carfentanil Rx

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Which of the following is the primary benefit of combining NMES with exercise rather than using either intervention alone?

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Which of the following is the primary benefit of combining NMES with exercise rather than using either intervention alone?

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A. Increased patient comfort during stimulation

B. Reduced metabolic demand on the muscle

C. Improved muscular recruitment and strength gains

D. Enhanced cardiovascular conditioning

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When utilizing TENS for an acute pain, which of the following frequencies and durations would be best to use?

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When utilizing TENS for an acute pain, which of the following frequencies and durations would be best to use?

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a. High frequency low duration

b. high frequency high duration

c. low frequency low duration

d. low frequency high duration

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Which of the following statements best explains a key difference between voluntary muscle contraction and contraction induced by NMES? 

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Which of the following statements best explains a key difference between voluntary muscle contraction and contraction induced by NMES? 

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A. Voluntary contraction recruits large-diameter motor units first.
B. NMES mimics natural recruitment by activating small fibers first.
C. NMES recruits large motor units before smaller ones, reversing the natural order.
D. Voluntary contractions result in more fatigue than NMES contractions.

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Which of the following is NOT a primary result found in studies of FES during walking for impaired individuals?

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Which of the following is NOT a primary result found in studies of FES during walking for impaired individuals?

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A)Decreased energy cost due to more efficient muscle activation

B)Increased mobility scores

C)Increased gait speed and stride

D)Increased energy cost due to increased muscle activation

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Which of the following patient situations would it be most appropriate to use Functional Electrical Stimulation (FES)?

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Which of the following patient situations would it be most appropriate to use Functional Electrical Stimulation (FES)?

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A. A patient with LBP for 3 years

B. A patient 4 weeks s/p TKA with quad weakness

C. A patient with calf pain after straining it 5 days ago

D. A patient with multiple sclerosis that has difficulty walking

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Grant Aloan is a 15-year-old patient s/p ACL reconstruction 6 weeks ago. He presents with visible atrophy of right quadriceps, limited voluntary contraction, and difficulty with straight leg raises and terminal knee extension. The rehab team decides to use NMES to target quad strengthening during supervised sessions. The patient is motivated and demonstrates good tolerance to e-stim. Which of the following would most likely be the clinical rationale for using NMES on this patient?

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Grant Aloan is a 15-year-old patient s/p ACL reconstruction 6 weeks ago. He presents with visible atrophy of right quadriceps, limited voluntary contraction, and difficulty with straight leg raises and terminal knee extension. The rehab team decides to use NMES to target quad strengthening during supervised sessions. The patient is motivated and demonstrates good tolerance to e-stim. Which of the following would most likely be the clinical rationale for using NMES on this patient?

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a)        To stimulate sensory afferent nerves and reduce pain perception associated with early weight bearing.

b)        To replace the need for voluntary muscle contraction and avoid overloading the surgical repair.

c)        To facilitate motor unit recruitment and promote early activation of the quads during rehab.

D). To enhance lymphatic drainage by producing rhythmic twitch contractions around the knee joint.

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When using quad-polar electrode placement, what must you have to get the outcome you want?

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When using quad-polar electrode placement, what must you have to get the outcome you want?

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A) 2 currents of the same frequencies

B) 3 currents of different frequencies

C) 3 currents of same frequencies

D) 2 currents of different frequencies

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A 38 year-old female with Chronic LBP is referred to physical therapy. The pain constant, dull, and interferes with her ability to sit at work. She prefers not to take any medication for pain control. Which E-Stem modality is most appropriate for managing chronic pain through gate control theory?

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A 38 year-old female with Chronic LBP is referred to physical therapy. The pain constant, dull, and interferes with her ability to sit at work. She prefers not to take any medication for pain control. Which E-Stem modality is most appropriate for managing chronic pain through gate control theory?

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A. Tens

B NMES

C. IFC

D. FES

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From this image of a pulsed current, which of the following labelled characteristics represents the inter-pulse interval?

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From this image of a pulsed current, which of the following labelled characteristics represents the inter-pulse interval?

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A. 1

B. 2

C. 5

D. 6

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Which of the following do you need to keep in mind when using muscle re-education NMES on a patient?             

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Which of the following do you need to keep in mind when using muscle re-education NMES on a patient?             

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A. A minimum of 30-minute treatment time

B. A continuous duty cycle

C. Voluntary muscle contraction

D. A muscle twitch you can feel but not see

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A 60-year-old female with a history of RA presents to PT with c/o pain and inflammation in her wrists and elbows. She has tried over-the-counter medications but has continued to experience flare-ups. Her PT recommends iontophoresis to manage inflammation and pain in the joints. Dexamethasone will be used for the treatment. Which of the following is the most important consideration when using iontophoresis for this pt. with RA?

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A 60-year-old female with a history of RA presents to PT with c/o pain and inflammation in her wrists and elbows. She has tried over-the-counter medications but has continued to experience flare-ups. Her PT recommends iontophoresis to manage inflammation and pain in the joints. Dexamethasone will be used for the treatment. Which of the following is the most important consideration when using iontophoresis for this pt. with RA?

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A. The electrodes should be as close as possible to ensure the effective transfer of the ion across the skin.

B. The PT should use a high amplitude with small electrodes.

C. The negative electrode should be placed over area of inflammation.

D. Iontophoresis is contraindicated for patients with RA.

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A 34 yr old woman in active labor reports moderate lower back pain, which she describes as "constant and aching".She prefers to avoid pharmacological pain relief options. Which of the following is the most appropriate treatment choice for this patient to alleviate her low back pain during labor?

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A 34 yr old woman in active labor reports moderate lower back pain, which she describes as "constant and aching".She prefers to avoid pharmacological pain relief options. Which of the following is the most appropriate treatment choice for this patient to alleviate her low back pain during labor?

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A) Moist heat pack over the abdomen

B) Continuous ultrasound over the lower back

C) TENS over the lower back

D) NMES to the lumbar area

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Which adjunct biophysical agent is used after iontophoresis to keep medication localized to the target site?

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Which adjunct biophysical agent is used after iontophoresis to keep medication localized to the target site?

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A. Ice

B. Exercise

C. Continuous ultrasound

D. Diathermy

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5.	When documenting NMES, which of the following can be used as rationale for treatment?

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5.	When documenting NMES, which of the following can be used as rationale for treatment?

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A. Sensory Stimulation

B. Neuromuscular Re-education

C. Pain Modulation Using Gate Theory of Pain

D. Chronic Pain Management

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A 62-year-old male is referred to physical therapy following a left middle cerebral artery (MCA) stroke 3 months ago. He presents with right-sided hemiparesis and notable foot drop on the affected side. During gait assessment, the therapist observes decreased clearance during the swing phase and frequent toe drag on the right. The patient ambulated household distances with a single-point cane and demonstrates good cognitive function and motivation to participate in therapy.

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A 62-year-old male is referred to physical therapy following a left middle cerebral artery (MCA) stroke 3 months ago. He presents with right-sided hemiparesis and notable foot drop on the affected side. During gait assessment, the therapist observes decreased clearance during the swing phase and frequent toe drag on the right. The patient ambulated household distances with a single-point cane and demonstrates good cognitive function and motivation to participate in therapy.

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As part of the treatment plan, the therapist decides to incorporate electrical stimulation during gait training to improve the patient’s walking mechanics and promote active dorsiflexion during swing phase. Which of the following is the MOST appropriate type of electrical stimulation to use in this scenario?

A. Transcutaneous electrical nerve stimulation (TENS)
B. Functional electrical stimulation (FES)
C. Neuromuscular electrical stimulation (NMES)
D. Interferential current (IFC)

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Pregnancy is usually considered a contraindication for TENS usage on the back and abdomen. However, there is recent research on a specific application of TENS that is found to be safe and beneficial during pregnancy. Which of the following is the recognized exception? 

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Pregnancy is usually considered a contraindication for TENS usage on the back and abdomen. However, there is recent research on a specific application of TENS that is found to be safe and beneficial during pregnancy. Which of the following is the recognized exception? 

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a. Reduce round ligament pain during pregnancy

b. Stimulate fetal movement

c. Pain relief during labor and delivery

d. Diastasis recti treatment during pregnancy to slow down softening of the linea alba

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Martha is a 34 year old patient s/p right CVA causing left sided weakness. She is struggling to be able to walk within the community because she’s having trouble activating muscles in her lower extremity and her left foot keeps dragging. Which of the following is the best intervention to help Martha while she’s walking around her community?

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Martha is a 34 year old patient s/p right CVA causing left sided weakness. She is struggling to be able to walk within the community because she’s having trouble activating muscles in her lower extremity and her left foot keeps dragging. Which of the following is the best intervention to help Martha while she’s walking around her community?

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a. Use a foot drop stimulator while walking to induce left foot dorsiflexion while walking (an FES technique)

b.  Use a foot drop stimulator while walking to induce left foot dorsiflexion while walking (a Sensory TENS technique)

c.Use noxious TENS to induce dorsiflexion for 40 minutes passively

d. Use a IFC quadripolar electrode set up with sensory TENS around the ankle to induce dorsiflexion while walking

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A 60 year-old pt. presents to physical therapy with subluxation of the left shoulder s/p a right CVA 6 weeks ago. The physical therapist decides to use functional electrical stimulation (FES), a subtype of NMES, for muscle re-education. Which of the following would be the most appropriate electrode placement for this method?

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A 60 year-old pt. presents to physical therapy with subluxation of the left shoulder s/p a right CVA 6 weeks ago. The physical therapist decides to use functional electrical stimulation (FES), a subtype of NMES, for muscle re-education. Which of the following would be the most appropriate electrode placement for this method?

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A.   Bipolar placement on the supraspinatus and posterior deltoid

B.    Unipolar placement on the middle deltoid

C.    Bipolar placement on the supraspinatus and anterior deltoid

D.   Unipolar placement on the supraspinatus

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What is the difference between NMES and voluntary skeletal muscle? 

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What is the difference between NMES and voluntary skeletal muscle? 

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A. Since there is little to no difference, NMES can be used to completely replace other forms of physical therapy when a patient does not feel like exercising?

B NMES will never fatigue muscles, unlike voluntary contractions.

C NMES is different since it activates small fibers first, then large, while voluntary muscle contraction is vice versa to this.

D NMES is different since it activates large fibers first, then small, while voluntary muscle contraction muscle is the opposite of this.